Healthcare Provider Details

I. General information

NPI: 1710046966
Provider Name (Legal Business Name): PAMELA SUE WARMERDAM MS RD CDE CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 W EATON AVE
TRACY CA
95376-3420
US

IV. Provider business mailing address

471 W EATON AVE
TRACY CA
95376-3420
US

V. Phone/Fax

Practice location:
  • Phone: 209-832-3432
  • Fax: 209-839-6742
Mailing address:
  • Phone: 209-832-3432
  • Fax: 209-839-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberR703135
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number09910714
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number003321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: